Peribulbar Anesthesia Research Articles

Comparable pain scale, onset, and duration of anesthesia in sub-Thenon’s and peribulbar anesthesia in vitrectomy: A pilot study

Comparable pain scale, onset, and duration of anesthesia in sub-Thenon’s and peribulbar anesthesia in vitrectomy: A pilot study

Levobupivacaine Combined with Cisatracurium in Peribulbar Anaesthesia in Cats Undergoing Corneal and Lens Surgery

The aims of the study included evaluating the effects of levobupivacaine combined with cisatracurium on akinesia and mydriasis when administered by peribulbar injection, and evaluating if the chosen dose of cisatracurium is enough to avoid the use of systemic neuromuscular blockade in cats. The animals were divided into four groups as follows: group L received 1.25 mg kg-1 levobupivacaine administered by peribulbar injection; group LC received the same dose of levobupivacaine combined with 0.01 mg kg-1 of cisatracurium administered by peribulbar injection; group C received 0.01 mg kg-1 of cisatracurium administered by peribulbar injection; group GC received 0.01 mg kg-1 of cisatracurium intravenously. Physiological variables, intraocular pressure, akinesia, and mydriasis were measured before and up to 30 min after peribulbar injection. The onset of akinesia, duration of akinesia, and train of four (TOF) were evaluated. Physiological variables remained in the physiological range in all groups. Effective akinesia and mydriasis were observed in all groups. The (TOF) was 0.9 in all groups. Throughout the study was observed in group LC a shortened onset of akinesia and a prolonging its duration. The peribulbar injection of cisatracurium and levobupivacaine provided effective akinesia and mydriasis, and shortened the onset of akinesia while prolonging its duration.

Neostigmine and ketorolac as adjuvants to local anesthetic through peribulbar block in patients undergoing vitrectomy surgeries: A randomized controlled trial

ABSTRACT Background This study aimed to assess the safety and efficacy of a neostigmine/ketorolac combination as an adjuvant to a low-dose local anesthetic mixture used for peribulbar block during vitrectomy surgeries. Methods This double-blinded, parallel-group, randomized trial enrolled 50 adult patients of both genders who were American Society of Anesthesiologists physical status I or II and were scheduled for vitrectomy surgeries under regional anesthesia. All patients underwent peribulbar block through a single medial canthus injection technique. In the neostigmine and ketorolac (NK) group, 25 patients received a combined mixture of neostigmine (300 μg) and ketorolac (4 mg/ml) as adjuvants to a mixture of lidocaine (2%, 2.5 ml) and bupivacaine (0.5%, 3.5 ml) containing 75 units of hyaluronidase. The control (C) group received 1.5 ml of normal saline instead of neostigmine/ketorolac. The primary outcomes were the onsets and durations of both sensory and motor blocks. Secondary outcomes included the time to first analgesic dose, hemodynamics, adverse effects, and patient’s and surgeon’s satisfaction. Results The onsets of sensory and motor blocks were significantly shorter in the NK group compared to the C group. A significantly longer anesthesia and akinesia duration were observed in the NK group in comparison to the C group. The meantime to the first analgesic dose showed a significant difference between the NK and C groups. The NK group had a higher rate of adverse effects than the C group, though not reaching statistical significance. Patients’ and surgeons’ satisfactions were significantly higher in the NK group than the C group. Conclusions In peribulbar anesthesia for vitrectomy surgery, adding neostigmine/ketorolac combination to a low-dose local anesthetic mixture was effective in reducing the onset and prolonging the duration of both sensory and motor block, and it was associated with higher safety and better patients’ and surgeons’ satisfaction.

Comparative study between conventional and 4 mm manual small-incision cataract surgery.

Comparative study of intraoperative and postoperative complications, visual outcomes, and cost-effectiveness between conventional and 4-mm manual small-incision cataract surgery with MVR blade. In total, 600 patients having nuclear sclerosis grade I-IV were operated under peribulbar anesthesia and were divided into two groups of 300 each. In group A (300), conventional small-incision cataract surgery was done, whereas in group B (300), 4-mm manual small-incision cataract surgery was performed through a 4-mm sclerocorneal tunnel. A wire vectis was passed through the 4-mm incision below the nucleus to stabilize it, and a 20-G MVR blade was introduced from 11o'clock limbus and nucleus was bisected into two halves, which were removed through main incision. Cortical wash was given, and foldable IOL was implanted. Intraoperative and postoperative complications between the two groups were compared. Postoperative visual outcome and surgically induced astigmatism between the two groups was studied. The most common intraoperative complication was hyphema (11.33%) and irido-dialysis (8.00%), whereas postoperatively, striate keratopathy (36.33%) and hyphema (19.33%) were common. Short-term complications such as striate keratopathy, hyphema, and irido-dialysis were significantly more in group B, and long-term results in terms of visual outcome and surgically induced astigmatism were significantly less in group B. Although intraoperative and short-term postoperative complications were observed more in 4-mm manual small-incision cataract surgery, it was found to be more effective in terms of surgically induced astigmatism and final visual outcome. In addition, it is cost-effective as compared to phacoemulsification.

Comparative study to assess the effect of ropivacaine and a mixture of lidocaine and bupivacaine on intraocular pressure after peribulbar anesthesia for cataract surgery.

To compare the efficacy of ropivacaine with a mixture of lidocaine and bupivacaine in peribulbar anesthesia for cataract surgery, in terms of post-block intraocular pressure (IOP). A one-year comparative study was done to compare two anesthetic solutions in peribulbar anesthesia for cataract surgery, from January 2020 to December 2020 at a tertiary health care hospital. Two hundred patients (40-70 years of age) planned for small-incision cataract surgery with posterior chamber intraocular lens (IOL) implantation under peribulbar anesthesia were included in the study. A single-site inferotemporal injection was given till a total eyelid drop was observed. The IOP was measured at four time-points: before block (control), 1-, 5-, and 15-minute post-block with a tonometer. The 1-minute post-block mean IOP in both the groups was higher than the baseline levels. This reflected raised intraorbital pressure secondary to peribulbar injection of local anesthetic. However, the rise in 1-minute post-block IOP was significantly less in the ropivacaine group. The 5- and 15-min post-block mean IOP values in the ropivacaine group were significantly lower than the corresponding values of the lidocaine-bupivacaine group and baseline (control) ropivacaine values. The results of this study support that ropivacaine as a local anesthetic drug for peribulbar block for small-incision cataract surgery can be a suitable alternative to the lidocaine-bupivacaine combination. Studies involving a larger sample size are required to consider ropivacaine as a superior drug to the lidocaine-bupivacaine combination.

Manual small-incision cataract surgery under topical anesthesia.

Manual small-incision cataract surgery is one of the most common surgical procedures in ophthalmology. Most cataract surgeries are performed under local anaesthesia. Peribulbar or retrobulbar anaesthesia is commonly used to achieve analgesia and akinesia during surgery but it has various complications. Our aim was to study patient comfort and surgeon's perspective in terms of patient cooperation in MSICS under topical anaesthesia using only proparacaine 0.5% eye drops without any periocular block or intracameral drug. Also to popularise Topical MSICS similar to Topical Phacoemulsification. A prospective analytical study of 33 patients who underwent MSICS surgery from March 2022 to June 2022 using Topical proparacaine eye drops 0.5% was done and patient's comfort and surgeon's perspective in terms of patient cooperation was studied on a scale of 1-5. Out of 33 patients who underwent surgery, the average comfort score based on patient feedback was 3.45± 0.96 and average patient cooperation score based on surgeon assessment was 3.42 ± 1.07 on a scale of 1-5. We concluded that MSICS using only topical proparacaine 0.5% eye drops, can provide sufficient patient comfort and can avoid complications related to peribulbar anaesthesia. Hence it can be used in large scale cataract surgeries and also provides economical utilisation of resources, lesser complications and early post operative recovery without compromising surgical outcome.

Minimal anesthetic manual small-incision cataract surgery (MSICS): A novel technique in use for anesthesia in MSICS.

Ever-evolving modern day cataract extraction techniques have been accompanied by the use of smaller quantities and less invasive methods of anesthesia. Topical anesthesia is routinely used for phacoemulsification. However, peribulbar block or some modification of it is used for anesthesia in manual small-incision cataract surgery (MSICS) by most practitioners. The authors describe a technique using a combination of 1.5-2 milliliters of anesthetic mixture given subconjunctivally and supplemented with commercially available intracameral anesthetic and mydriatic for MSICS. It is possible to get high level of anesthetic effect and ease of surgery with this technique though there is a small learning curve. Several modifications from topical phacoemulsification like two side ports six o'clock hours apart make this surgery easy to adapt to. No special instrumentation is required. It gives adequate analgesia and anesthesia to complete the surgery. a minimalistic anesthetic approach in MSICS can be used with enhanced safety and by avoiding usual complications of traditional peribulbar and retrobulbar anesthesia.

Globe penetration during loco-regional anesthesia: prevalence and review of cases.

To describe prevalence and different clinical signs and management of cases with penetrating eye injuries during loco-regional anesthesia for ophthalmic surgery. A retrospective review of clinical records was carried out, identifying cases of globe penetration secondary to peribulbar anesthesia injection during 5y activity in Centro de Oftalmología Barraquer. A total of 17 460 needle-based ocular anesthesia procedures were performed in our centre and 4 cases of globe penetration were recorded with an estimated prevalence of 0.024%. Globe penetrations were always detected in the first 24h after surgery. Vitreous haemorrhage was found in all the cases. Two eyes presented retinal detachment and two eyes choroidal detachment (CD). The initial surgical approach was performed within the first 48h. Silicone oil was used as tamponade in three eyes and the fourth case remained only with air. Detachments were solved successfully in all the cases. Functional results varied among cases, depending on ocular remarkable antecedent and globe penetration with or without retinal or CD. Prevalence of globe penetration during loco-regional anesthesia is low in our centre. Physicians should consider the possibility of globe penetration in eyes with postoperative atypical appearance after loco-regional anesthesia. Immediate B-scan ultrasonography is recommended in suspicious cases with a dense vitreous haemorrhage. An early vitrectomy surgery in conjunction with laser or cryotherapy at the penetration sites is essential for good anatomical and functional results.

A comparative study of subtenon’s anaesthesia with peribulbar anaesthesia for manual small incision cataract surgery in patients with age related cataracts

To compare the safety, efficacy and ease of administration of subtenon’s anaesthesia with peribulbar anaesthesia in manual small incision cataract surgery(MSICS) and assess the surgeon and patient comfort.A prospective longitudinal study was conducted among 200 patients undergoing MSICS at a rural tertiary care hospital wherein patients were randomly divided into the two groups of peribulbar (P) and subtenon’s (ST) block.After randomization, 200 patients were assessed for various factors including pain at the time of administration of anaesthetic, time to attain akinesia, patient’s comfort and satisfaction score.200 eyes of 200 patients who underwent MSCIS were divided into Peribulbar and Subtenon’s group by random number table; of which 122 were women (61%) and 78 were men (39%). There was a significant difference in the amount of anaesthetic used, with the group P (8.37+1.19 ml) usage being more than the group ST(4.02+0.91 ml) (p<0.001). Group P took significantly lesser time to attain akinesia compared to group ST. Group P achieved significantly higher degree of akinesia than group ST. (p<0.001) Significantly greater number of eyes in the group ST required additional anaesthetic injection compared to the group P (p<0.001). A significantly more number of patients experienced pain in the group P. (p=0.008)Significantly greater number of eyes in group ST had mild and moderate chemosis and subconjunctival haemorrhage compared to group P(p<0.001).We found that subtenon’s anaesthesia was an equally effective technique for achieving analgesia and akinesia when compared to peribulbar anaesthesia in patients undergoing MSICS.

Ultrasound-guided versus conventional peribulbar anaesthesia in cataract surgery: A randomised controlled study.

Blind ophthalmic anaesthetic techniques may have serious complications. To assess the safety of ultrasound as a guide in ophthalmic blocks. Fifty adult patients undergoing cataract surgery under peribulbar block anaesthesia were randomly assigned to ultrasound-guided and conventional block groups. In the ultrasound-guided block group, a large amount of the standard ultrasound gel was applied to the closed eyelids. The globes were scanned in both sagittal and transverse planes. The patients were asked to look straight ahead with closed eyes without clenching the eyelids. The depth and gain were adjusted before performing the block. The primary outcome was the rate of complications. Secondary outcomes included the volume of injected anaesthetics and surgeon and patients' satisfaction. The local anaesthetic volume used was not significantly different between the two groups (7.08 ± 1.66 and 6.72 ± 1.97ml). The block onset, time and quality were comparable in both groups. No complications were reported, and there were no significant differences regarding surgeons' or patients' satisfaction with either procedure. The ultrasound-guided local ophthalmic block is as safe as the conventional method. Although its use was not superior to the conventional procedure, direct visualisation with ultrasound may be important to avoid vulnerable structures such as staphylomas.

Combined Subconjunctival Atropine and Intracameral Epinephrine Injection for Pupil Dilation in Phacoemulsification under Peribulbar Anesthesia

Combined Subconjunctival Atropine and Intracameral Epinephrine Injection for Pupil Dilation in Phacoemulsification under Peribulbar Anesthesia

Clinical features, management, and outcomes of expulsive choroidal hemorrhage during cataract surgery: 13-year experience of a tertiary eye center.

To study the risk factors, clinical features, management, and outcomes of intraoperative expulsive choroidal hemorrhage (ECH) during cataract surgery. Aravind Eye Hospital, Madurai, Tamil Nadu, India. Retrospective hospital-based study. Of the 1 167 250 patients who underwent cataract surgery between 2008 and 2020, patients diagnosed with intraoperative ECH were included. Demography, ocular and systemic risk factors, visual acuity, type of ocular anesthesia, intraoperative and postoperative records, management, and surgical outcomes were analyzed. 52 eyes (0.004%) of 1 167 250 patients had ECH. Of the 52 cases, 43 cases (incidence rate 0.006%) were reported in the years 2008 to 2015 and 9 cases (incidence rate 0.002%) in the years 2016 to 2020. The change in the ocular anesthesia from peribulbar and retrobulbar anesthesia (2008 to 2015) to sub-Tenon anesthesia (2016 to 2020) was associated with a reduced rate of ECH ( P = .002). 28 eyes (53.8%) experienced limited ECH and 24 eyes (46.2%) full-blown ECH. The visual outcome was better in eyes with limited ECH compared with full-blown suprachoroidal hemorrhage in all follow-up visits. The median vision (interquartile range) before the cataract surgery and at postoperative day 1 were 1.30 (0.78 to 2.60) and 2.45 (1 to 2.75), respectively. The median final vision (interquartile range) after the secondary surgical intervention was 2.2 (0.60 to 2.60). This series included 52 eyes with ECH, recognized associations of ECH with different types of anesthesia and with different cataract surgical procedures, and described management of ECH. Postoperative visual outcome was poor.

Topical Vs Pribulbar Anesthesia in Patients Undergoing 23 Guage ,Three Ports Removal of Sillicone Oil

Objective: To compare safety as well as efficacy of topical anesthesia against peribulbar anesthesia for patients undergoing three ports pars plana removal of silicone oil . Background: Silicone oil is used as a temponarding agent for vitreoretinal procedures and have to be removed according to the duration of temponard required as it is associated with complications like development and acceleration of cataract devlopment , secondary open angle glaucoma and corneal decompensation. It can be removed via three port 23 gauge ROSO procedure both under topical and peribulbar anesthesia. Patients & Methods: 40 eyes from 40 patients who underwent three port ROSO with a 23 gauge port system were randomised into two groups of 20 patients each for this study. In group A eyes was operated under topical anesthesia using soaked cotton wisk with 0.5 % proparacaine hydrochloride , placed for five minutes in superior and inferior fornix before the start of surgery and the group B was operated under peri bulbar block with 4 ml of bupivacaine given five minutes before the start of surgical procedure. Pain scoring charts were used by patients to rate their pain after the procedure. Results: The patients in this study had a mean age of 58.46 ±3.62 years, with a range of 30-65 years. 40 individuals were treated, with 26 being male and 14 being female. The mean pain score for patients in topical anesthesia group was 3.8+- 0.5 and the mean pain score in peribulbar block group was 2.2+-0.2 with a p value of 0.01. Conclusion: Peribulbar block is superior to topical anesthesia in patient comport for patients undergoing three port ROSO procedures. Keywords: ROSO, Silicone oil, peribulbar, Topical anesthesia, Bupicaine, Proparacaine hydrochloride.

A Case Report Total Intravenous Anesthesia Combined with Peribulbar Block in Vitrectomy Operation with Heart Disorder

Introduction: Vitrectomy is eye surgery to evaluate the retina by removing the vitreous gel which is principally carried out in three stages, namely retinal detachment repair, membrane peeling, and crystalline lens. In this operation, the anesthetic technique that needs to be emphasized is not increasing intraocular pressure and avoiding the oculocardiac reflex. This operation can be performed with a peribulbar or retrobulbar block, however, total intravenous anesthesia may also be considered in patients with other comorbidities.Case Presentation: Male, 55 years old, 96 kgs, with the chief complaint of blurred vision in the last 3 weeks ago. There were no other complaints but the patient has a history of hypertension, diabetes mellitus type II, congestive heart failure with a history of mitral valve replacement (MVR), and permanent pacemaker (PPM) usage from 2015. The patient had a history of warfarin and novamox usage 7 days ago. From the exam, the patient was diagnosed with ablatio retina + post-MVR and scheduled to have a vitrectomy. The patient was positioned supine with 300 heads up. The patient was given 3 liters of oxygen via nasal cannula, premedicated with fentanyl 50 mcg, then induced with propofol 100 mg bolus intravenously until sleep nonapnea before continuing with continuous propofol via syringe pump. The patient was maintained by propofol 0.5 mg/kg BW/hour. Next, the patient was given a peribulbar block with 2mL Lidocaine 2% and 2mL Bupivacaine 0.5%. During operation, there was no significant hemodynamic fluctuation until finished. Conclusion: The patient thus will undergo vitrectomy can be performed with peripheral nerve blocks such as retrobulbar anesthesia or peribulbar anesthesia. However, after knowing about the patient’s medical history, in this case, with a history of cardiac events and also undergone open-heart surgery, total intravenous anesthesia combined with a peribulbar block was considered the most suitable technique.

Study on peribulbar versus topical anaesthesia in subjects undergoing phacoemulsification

Introduction: Phacoemulsification was first introduced by Charles Kelman in 1967. IOL implantation is done according to the power of lens calculated using various intra ocular lens (IOL) calculation formulae. By customizing the IOL during cataract surgery, we can provide patients with best refractive outcomes, even in high myopes and hypermetropes. Aim and Objective of the study: The objective of the study to compare the efficacy of topical Anaesthesia versus peribulbar anesthesia among the subjects undergoing phacoemulsification. Materials and Methods: Subjects included in the study were conveniently assigned into either peribulbar group (Group P, n = 100) and topical group (Group T, n =100). Group P received 4-5 mL of local anesthetic (equal amounts of 2% xylocaine and 0.5% bupivacaine) into peribulbar space with 1 inch 25-gauge needle. Group T, received 0.5% proparacaine eye drops instilled every 5 minutes half an hour before surgery. No sedation was given. All the patients under went phacoemulsification with IOL implantation. A four-point verbal pain scale was used for analgesia. Patients were asked to grade the pain during different stages of surgery. Akinesia was also assessed on four-point scale.

EFFECT OF ALKANISATION AND WARMING OF LIDOCAINE FOR PAIN REDUCTION IN PERIBULBAR ANAESTHESIA

Objective : Methods :To study the effect of alkanisation and warming of lidocaine for pain reduction in peribulbar anaesthesia. 100 patients were divided into 4 groups of 25 patients each to receive peribulbar injection. Group Co (Control) received 10 ml of plain 2% lidocaine solution at room temperature 18°C, Group W received 10 ml of 2% lidocaine solution at 37°C, Group BO received 10 ml of 2% lidocaine solution buffered to an estimated pH of 7.09 ± 0.10 and Group WBO received 10 ml of 2% lidocaine solution at 37°C buffered to an estimated pH of 6.92. Patients were explained about visual analogue scale to assess the pain received by them. Mean pain score obtained was 2.72, 1.70, 1.15 and 1.12 inResults : Group Co, Group W, Group BO and Group WBO respectively. Alkanized lidocaine with or without warming produces less pain thanConclusion : lidocaine injected at room temperature. Also, alkanization does not have a synergestic effect on warming for pain reduction in peribulbar anaesthesia. To study the effect of alkanisation and warming of lidocaine for pain reduction in peribulbar anaesthesia

Effect of adding dexmedetomidine to 0.75% ropivacaine in peribulbar block for vitreoretinal surgery.

Peribulbar anesthesia is suitable for vitreoretinal (VR) surgery. Dexmedetomidine has been used in peribulbar block (PBB) to improve akinesia and analgesia. We aimed to study the efficacy of adding dexmedetomidine to 0.75% Ropivacaine in PBB for VR surgery. The primary outcome was the requirement of block supplementation and secondary outcome was post-operative analgesic requirement. 100 adult patients undergoing VR surgery were included in this prospective randomized double-blinded controlled study. The composition of the drug used for PBB in the 3 groups was Group R (8 ml of 0.75% Ropivacaine +0.5 ml normal saline (NS)), Group D25 (8 ml of 0.75% Ropivacaine +25μg Dexmedetomidine) and Group D50 (8 ml of 0.75% Ropivacaine +50 μg Dexmedetomidine). The groups were comparable in terms of patient demographics. The requirement for block supplementation was 16.7% in Group R (5/30), 12.5% in Group D25 (4/32) and 8.8% in group D50 (3/34) (P = 0.64). The mean time to first request for post-operative analgesia was432 ± 362 min in Group R, 572 ± 339 min in Group D25 and 614 ± 394 min for Group D50 (P = 0.26). There was significant difference in the heart rate (P = 0.047), mean arterial pressure (P = 0.012) at 30 min and sedation (RASS) score at 15, 30, 60 (P < 0.001) and 120 (P = 0.019) min between the D50 and group R. Patients undergoing buckling procedures had significantly shorter time to request for analgesia (P = 0.003). Addition of dexmedetomidine does not offer advantage over 0.75% Ropivacaine in PBB for vitrectomy. Its benefit in more painful procedures like scleral buckle needs further validation.

A prospective comparative study of the effect of ocular digital compression and non-compression following peribulbar anaesthesia on visual acuity and pupillary reactions

A prospective comparative study of the effect of ocular digital compression and non-compression following peribulbar anaesthesia on visual acuity and pupillary reactions

Особенности анестезиологического обеспечения при проведении операций при повышенном внутриглазном давлении

Purpose. To develop an algorithm for selection of anesthetic drugs and their dosages for adequate and safe anesthesia during surgical interventions that are performed on patients to reduce elevated intraocular pressure and to minimize the complications that may arise during anesthesia. Methods. The study included 86 cases that underwent surgery to reduce elevated intraocular pressure; 34 surgeries were performed under sub-Tenon anesthesia (39.6 %), 2 under parabulbar (2.3 %) and 50 (58.1 %) under peribulbar regional anesthesia. All the patients underwent dynamic monitoring of homeostasis. Anesthesia support consisted of preoperative preparation, regional anesthesia and drugs administered as a bolus in the operating room. Results and discussion. A list of drugs used during operations performed with increased intraocular pressure has been compiled. The most rational and safe dosages of drugs have been determined. After the introduction of this algorithm, not a single complication was obtained as a result of anesthesia. Conclusions. Implementation of the algorithm for intraoperative anesthesia in patients with elevated intraocular pressure made it possible to achieve: 1) adequate nociceptive and psychoemotional protection; 2) comfort conditions both for patients and for medical personnel; 3) minimizing anesthetic risks and complications. Key words: anesthesiology; ophthalmology; glaucoma; increased intraocular pressure; regional anesthesia.

Надглазничный доступ перибульбарной анестезии как метод дополнительного обезболивания офтальмологических операций

Purpose. To evaluate the efficacy of additional peribulbar block with supraorbital approach with eyeball compression in retinal detachment surgery. Methods. 3 groups of patients, 10 people in each group were observed. In each group classical peribulbar anesthesia was performed. At the most painful moment, in group I a narcotic analgetic was applied. In group II the surgeon added a subtenon block, in group III a peribulbar block with supraorbital approach was administered. Results. According to the study, in the group where the additional peribulbar block was performed with the supraorbital approach, hemodynamic parameters remained stable, and patients did not feel any pain in comparison with the first two groups. Conclusions. This method of anesthesia provides a stable anesthetic effect during surgery and a long-term analgesic effect in the postoperative period. Key words: peribulbar blockade with supraorbital approach; eyeball compression; analgesic effect.